From Bangladesh to the world: scaling a low-cost model for vision care

The Reading Glasses for Improved Livelihoods (RGIL) model–first developed and tested in Bangladesh–gained international recognition, positioning VisionSpring as a key actor in expanding affordable vision services in low-income communities. Leading this work is Anne Coolen, a public health specialist with nearly two decades of experience across Africa and Asia.

In a recent conversation with The Daily Star, she discusses technology in global health, the RGIL model, community health workers, partnerships, and skills needed by young professionals.

TDS: The RGIL model has been implemented in several countries, including Bangladesh. What contextual or cultural adaptations were necessary to make the programme effective in Bangladesh, and what key lessons have been learned from this experience?

AC: The RGIL model, recognised by the World Health Organization and included in its Training in Assistive Products module, was first tested in Bangladesh. In 2006, VisionSpring and BRAC trained community health workers to screen for near-vision issues and refer complex cases, supported by clear protocols and locally adapted communication. 

Over time, training, supervision and messaging were refined for the Bangladeshi context. A key finding is that task-shifting basic screening to community health workers reduces pressure on specialists. The model has since expanded to Uganda, Malawi and Zambia, showing that improved vision also supports productivity, income and overall wellbeing.

TDS: What are the main challenges in maintaining the quality, training, and long-term retention of community health workers, and how does the organisation ensure effective referrals for patients requiring advanced eye care?

AC: Community health workers often operate without a formal salary, so sustaining motivation is critical. They require ongoing refresher training, supervision and support, and this becomes challenging when working with large numbers across multiple regions. 

One inspiration of the importance of this work came from Uganda, where a community health worker named Maria was among the first people screened during training. When she received her own reading glasses and realised she could read again, she immediately understood the impact it could have on others. That sense of personal transformation became her motivation to serve her community, and she remains one of the strongest performers in the programme.

For referrals, we maintain clear pathways to optometrists or ophthalmologists for conditions beyond basic near-vision correction. The role of the community health worker is to serve as the first point of contact, identify issues and channel people into appropriate care.

TDS: Strategic partnerships are vital for expansion. How has VisionSpring collaborated with other organisations to strengthen reach and service delivery across Bangladesh and other countries?

AC: In Bangladesh, we work closely with BRAC and Sajida Foundation, which help us reach communities across the country. We also work with the Ministry of Health and the Ministry of Road Transport and Bridges to align our programmes with national priorities. A recent example is our partnership with driver associations in Bangladesh. 

Through agreements facilitated by transport authorities, VisionSpring teams including more than twenty optometrists and a larger support network, operate in bus terminals to provide drivers with comprehensive vision services. The initiative is donor-funded, but drivers contribute a small registration fee to encourage attendance and consistent use of glasses.

TDS: Young people today are increasingly involved in social entrepreneurship and global health innovation. What advice would you give to young professionals seeking to build careers in international public health or development?

AC: Start from the ground up and stay humble. You need to understand the realities of the communities you hope to serve. Technology and innovation move fast, but if solutions are not rooted in local needs and perspectives, they will not be sustainable. Spend time listening, observing, and engaging with people whose lived experiences are very different from your own. And maintain strong critical-thinking skills – especially with the rise of AI, where information can be biased or inaccurate.

TDS: In your view, what emerging technologies hold the greatest promise for improving vision care and public health outcomes over the next decade?

AC: I see strong potential in simple, scalable technologies that bring services closer to people for example, basic digital mapping of underserved areas. Mobile phone based technologies are becoming more sophisticated and could expand access dramatically once testing, regulation and quality assurance catch up. 

But technology alone is not enough. It must be thoughtfully integrated into community systems, supported by strong training, and used in combination with human judgment. The potential is exciting, but we need to advance carefully to ensure accuracy, equity and safety.